Outcomes of various surgical techniques used in patients with closed traction injuries of the brachial plexus

Abstract

Introduction Traumatic lesions of the brachial plexus and analysis of the outcomes of various surgical techniques in patients with this pathology are the relevant challenges in neurosurgery, neurology, traumatology, orthopedics and rehabilitation due to the high social and economic significance, incidence and poor short- and long-term outcomes in this cohort of patients. This study was aimed at comparing the outcomes of various surgical techniques in patients with closed injuries of the brachial plexus. Material and methods The study involved 96 patients with closed injuries of the brachial plexus divided into three groups according to the method of their surgical treatment. Patients of Group I (n = 33) underwent microsurgical neurolysis of their brachial plexus trunks; patients of Group II (n = 28) had microsurgical neurolysis of their brachial plexus trunks with stimulating multichannel electrodes implanted on the trunks of their brachial plexus; patients of Group III (n = 35) had microsurgical neurolysis with stimulating multichannel electrodes implanted on the trunks of their brachial plexus as well as the segmental spinal cord apparatus at the level of the cervical intumescence. The clinical status and functionality of the upper limb were assessed after 6 months with clinical and neurological tests, scoring methods, and electrophysiological monitoring. Results We analyzed the outcomes of various surgical techniques in patients with closed injuries of the brachial plexus to prove a significant improvement in the outcomes of Group III patients who featured a faster rate of pain regression in the injured upper limb as well as significantly positive changes in clinical, neurological and electrophysiological indicators. Discussion The reduction in the total regional pain syndrome and restoration of the affected limb function was more evident in Group III patients what supports the favor of microsurgical neurolysis in combination with two-level electrical stimulation for closed injuries of the brachial plexus. Conclusions The analysis of various surgical techniques in patients with closed injuries of the brachial plexus revealed a significant efficacy of microsurgical neurolysis in combination with electrostimulation of the injured nerve trunk and segmental spinal cord apparatus (Group III). It improves the outcomes in this cohort of patients.

Keywords

• brachial plexus
• closed injuries
• surgical management
• electrostimulation